Healthcare Provider Details

I. General information

NPI: 1033044680
Provider Name (Legal Business Name): MARCELO ALEJANDRO ROLDAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10112 W MCDOWELL RD
AVONDALE AZ
85392-4841
US

IV. Provider business mailing address

10112 W MCDOWELL RD
AVONDALE AZ
85392-4841
US

V. Phone/Fax

Practice location:
  • Phone: 844-768-7107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012856
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: